Provider Demographics
NPI:1245871235
Name:KLAERS, KARISSA JOY
Entity type:Individual
Prefix:
First Name:KARISSA
Middle Name:JOY
Last Name:KLAERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:KARISSA
Other - Middle Name:JOY
Other - Last Name:TAWFEEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16023 62ND ST NE
Mailing Address - Street 2:
Mailing Address - City:OTSEGO
Mailing Address - State:MN
Mailing Address - Zip Code:55330-6423
Mailing Address - Country:US
Mailing Address - Phone:763-259-8086
Mailing Address - Fax:763-259-8086
Practice Address - Street 1:411 3RD ST SE
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:MN
Practice Address - Zip Code:55369-1606
Practice Address - Country:US
Practice Address - Phone:763-259-8086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-01
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNT650275605011OtherDRIVER'S LICENSE